resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
November, 2001, Vol. 01, Issue 11
Reflex Mechanisms of Massage Therapy, Part II
By Ross Turchaninov, MD
Editor's note: Part I of this article appeared in the October 2001 issue of Massage Today, available on line at www.massagetoday.com/archives/2001/10/05.html.
Why do stimuli from the stomach that are delivered to the central nervous system (CNS) radiate to somatic structures, and why in turn are the stimuli from reflex zones activated by the flow of motor impulses to the stomach? The phenomenon of convergence is responsible for this effect. The number of afferent sensory neurons delivering information from peripheral receptors to the spinal cord is greater than the amount of spinal neurons in the posterior horns of the spinal cord. The posterior horns accept and primarily process this information (see figure 2).
In other words, there is more than one sensory neuron in contact with each spinal neuron in the posterior horns of the spinal cord. In this instance, the information brought to CNS by sensory neurons from the stomach excites the entire neural plate of the spinal neuron. The sensory information delivered by sensory neurons from the peripheral receptors in the skin or skeletal muscles also excites the entire neural plate of the same spinal neuron. This stimulation by sensory stimuli from the stomach or reflex zones activates the lower motor cells in the anterior horns of the spinal cord. They generate motor input not only to the location of the original abnormality (the stomach, in our example), but also to the somatic structures innervated by the same segment of the spinal cord.
Simpler mechanisms of reflex zone formation are applied in cases of somatic abnormalities. This mechanism is responsible for the reflex zones' formation along the pathway of irritated or compressed peripheral nerves. For example, the chronic irritation of the sciatic nerve by overtensed piriformis muscle will produce pathological symptoms through the entire lower limbs. In this manner, irritation of peripheral nerves in the upper part of the body will cause the formation of reflex zones in the lower extremities, supported by the affected peripheral nerve.
Finally, reflex zone formation can be caused by direct compression of the spinal nerve by a herniated disc. As a result of irritation or compression of the spinal nerve, various areas of pathological excitement develop in the spinal cord, especially in the lower motor centers in the anterior horns. Abnormal impulses flow from the spinal cord to the inner organs, and to other parts of the body that are innervated by the affected spinal nerve. Further development follows the same pattern of relation between reflex zones and inner organs or parts of the body as mentioned previously.
Let's now look at another important issue, and ask another important question: "What local events lead to the formation of reflex zones?" First, let's briefly review the physiology of excitation and the conduction of nerve impulses. A nerve impulse or "action potential" is a propagated electrical disturbance originating in the peripheral receptors or in the upper nervous centers; it is conducted through afferent, ascending sensory or efferent, descending motor neurons. Both ascending information to the central nervous system about any kind of peripheral receptors activation, and descending motor commands from the central nervous system, are delivered as a series of action potentials. Any single action potential is the result of changes in the conductance of sodium and potassium through the membrane of the nervous cells. Every action potential has a threshold. A threshold is the firing level of the action potential. This means that if applied stimuli are weak, they are unable to evoke an action potential. In this case, full action potential is replaced by a local response.
A local response is a weak electric excitement that stays within the stimulated receptor, rather than propagating along the neuron. As soon as the stimuli are strong enough, the action potential is generated and conducted through the neuron. This mechanism protects the nervous system from overflow with useless information. Normally, the threshold activation of peripheral receptors has stable electrical magnitude. The continuous radiation of motor impulses to the reflex zones in skin, connective tissue, muscles, or periosteum evokes unusual phenomena in these tissues. The magnitude of the threshold is reduced in all receptors located in these areas. As a result, receptors start to generate action potentials as a response to even the weakest stimulus, even those that normally had subthreshold levels and have never produced action potentials. (Korr, 1947). This phenomenon is called hyperirritability. The affected soft tissues respond by building up tension, especially in contractile elements. Vasoconstriction and local edema are formed, further diminishing blood circulation and decreasing tissue metabolism.
The decrease of the threshold of peripheral receptors, i.e. the condition of hyperirritability, is the starting point of reflex zone formation (Korr, 1947; Glezer, Dalicho, 1955; Kunichev, 1985; Shterngertz, Belaya, 1994; Loginova, 2000). Figure 3 shows how the action potentials are generated, both in the receptors of the normal parts of the body and in the areas of reflex zones.
In 1947, in a series of brilliant clinical experiments, Prof. I. Korr showed that hyperirritability is a key to understanding reflex zone formation. In his experiments, Korr inserted microelectrodes in muscles with clinical symptoms of hypertonic abnormalities, then exposed his subjects to different types of stimulation: physical activity, decreased and increased temperature, loud sounds, bright light, etc. When subjects were exposed to each of these stimuli (even visual and auditory) the skeletal muscles in the area of reflex zones reacted with increased tension, which was detected by electromyography. This caused the additional decrease of peripheral circulation in already-affected areas. Thus, as Prof. I. Korr showed, any type of sensory stimulation of the CNS causes the further development of reflex zones in the tissue which are no longer protected from theactivation of peripheral receptors by subthreshold stimuli.
A number of clinical abnormalities can be found found in the areas of reflex zones in the skin, connective tissue, skeletal muscles and periosteum. During diagnostic examination, the practitioner should detect all abnormalities and record them on prepared diagrams of the body. At the end of the diagnostic examination, the practitioner will have a complete picture of somatic abnormalities for the patient. Such an approach to diagnostic examination allows the practitioner to formulate the optimal treatment protocol.
I. Cutaneous Reflex Zones
II. Connective Tissue Zones (CTZ)
Connective tissue zones are also examined by palpation. Several diagnostic techniques target the CTZ in the each level. In general, the practitoner is looking for following abnormalities in the areas of CTZ:
III. Reflex Zones in Skeletal Muscles
Reflex zones in the skeletal muscles are examined by palpation and direct compression. The moderate compression of muscular tissue elicits sharp pain in the area of hypertonic muscular abnormalities. Patients show the so-called "jump symptom." Sharp pain elicited during moderate compression is another example of hyperalgesia.
IV. Periostal Reflex Zones
The periosteum is the thin connective tissue membrane covering all bones. It supports bone metabolism and remodeling. The periostal reflex zones are available for diagnostic examination only in the areas at which bone structures are covered by skin only. Examination of periostal reflex zones is conducted by palpation and direct compression.
Following diagnostic examination, the practitioner will able to formulate the proper protocol of medical massage therapy. The formulation of a correct protocol is of course key to successful treatment. As mentioned, this protocol is a combination of different methods and techniques. For example, connective tissue massage is the best way to work on the connective tissue zones, but it is useless in the areas of periostal reflex zones, where periostal massage is the most effective therapy. The practitioner must utilize the particular methods and techniques created for the treatment of particular type of reflex zones. For example, if the patient does not have abnormalities in the periosteum, periostal massage techniques must be excluded from the protocol. However, if one measures the clinical validity of different methods of medical massage, I believe that segment-reflex massage is as appropriate as all known methods of Western medical massage therapy. The major advantage of segment-reflex massage is its integrative approach to treatment.The modern protocol of segment-reflex massage includes therapeutic massage, connective tissue massage and periostal massage, as well as its own therapeutic techniques and approaches. This unique combination allows the practitioner to target the reflex zones precisely and deliver an effective therapeutic impact to the affected areas of the body. In any case, the protocol of medical massage therapy must be individually adjusted to each new patient, because there are no two identical cases.
In conclusion, I want to emphasize that reflex mechanisms of massage therapy allow the massage practitioner reach a completely new level of professional expertise. At first, the clinical application of reflex mechanisms of massage therapy is a challenge. However, the professional benefits are far more rewarding than the time spent by the practitioner to achieve this level of expertise.
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