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Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
January, 2002, Vol. 02, Issue 01
Medical Massage Therapy: The Search for Definition
By Gregory T. Lawton, DN, DC
Attempts to present and to define medical massage therapy vary from teacher to teacher and author to author. This article presents concepts related to medical massage therapy, a form of manual therapy routinely practiced by medical physicians and medical personnel during the 19th century.Medical massage therapy lost popularity in medical circles with the advent of the "drug era," along with many traditional forms of health care, such as midwifery and herbal medicine. State and national laws were developed which prohibited the legal practice of medical massage or natural health care for medical purposes. This government action resulted in the current condition of massage therapy as a lay practice based on esoteric principles and theory.
Currently, there is a movement within the massage profession to restore the historic medical applications of massage and manual therapy. Currently, most schools of massage therapy teach Swedish massage (also referred to as therapeutic massage) and/or variations of Swedish massage technique, or specialized systems of manual therapy such as shiatsu. Most of the western systems of conventional massage therapy, especially techniques taught in the United States, are based on the work of Per Henrik Ling, who formulated the general and relaxation techniques of Swedish massage (also referred to as therapeutic massage). In 1892, Emil Kleen, MD, PhD, author of Handbook of Massage commented on Ling and Swedish massage:
This "unfortunate defect" still plagues massage therapy, as there are very few studies that presently substantiate the medical claims of massage therapy. In addition, there are few massage therapists that have the doctoral or scientific credentials needed to study and present findings related to massage therapy research. In a research paper written by Justus J. Fiechtner, MD, MPH and Raymond R. Brocheur, DC, PhD ("Manual and manipulation techniques for rheumatic disease," published in Rheumatic Disease Clinics of North America, Volume 26, Number 1, February 2000), the authors state:
Conclusions regarding the effectiveness of massage therapy in the treatment of musculoskeletal disorders or disease are largely based on subjective and empirical evidence presented by massage therapists over hundreds of years. While this collection of empirical evidence is large and impressive, it does not address the more scientifically refined questions regarding specific modalities of treatment directly applied to particular disease states.
Conventional medicine likes to offer the supposition that its therapies are all scientifically validated. On the contrary, much of standard medical practice, including commonly performed invasive techniques and drug therapies, are not well studied, and/or the mechanisms of their activity, effectiveness and safety are unknown. We can all recall "routine" medical practices and procedures that, although practiced for many years, are now either no longer performed or discouraged. New drugs are brought to the market place with studies that involved small trial groups; when approved and utilized by larger groups, their side effects lead to death, disease and removal from the market.
While massage therapy as a profession lacks the kind of scientific studies called for by medicine, massage therapy technique and treatment enjoy a long history -- over 11,000 years worldwide -- which allows for another kind of scientific evidence, based on the collective clinical observation of thousands of massage therapy practitioners from many global cultures. Clinical observation with the systematic collection of clinical data has long been a tool of science; indeed, it resulted in Edison's invention of the light bulb. In addition, studies on massage therapy usually involve the general and superficial techniques of Swedish massage. For example, a study might indicate in its abstract that patients with back pain received a "back massage." Medicine remains in this new millennium largely ignorant of the various techniques, school of techniques, and variety of treatment protocols that exist in the many forms that massage therapy is practiced. Most massage therapy professionals employ several different techniques, exercises and modalities in a typical patient treatment session, making it difficult to quantify the effects of a single technique. Future studies need to identify the specific techniques of different manual therapy systems, and study the exact clinical effects of those techniques.
Medical massage therapy, by the adoption of the qualifying word, "medical," should be able to demonstrate clinical results when placed under scientific scrutiny. This supposition is as yet unproven by conventional research. While limited studies do exist, and the data continues to increase regarding the generalized effects of Swedish massage, there are almost no studies on medical massage technique and protocol. The medical massage therapist must borrow from research data that has been performed in other manual therapy disciplines, such as orthopedic medicine, physical therapy, chiropractic and acupuncture, and studies on the biochemistry, physiology and histology of soft tissue structures of the body.
Medical training and research in the United States is largely subsidized by the pharmaceutical industry. The awarding of research grants is heavily influenced by the drug industry and medical bias. This situation has resulted in money being directed at finding the most profitable therapies rather than the most effective ones.
Massage therapy is experiencing a slow and gradual movement within the profession toward higher levels of academic standards, longer periods of study, entry into the profession by allied medical personnel, and acceptance into colleges, hospitals and medical clinics. However, there are few training programs in massage therapy schools that meet the needs of students of higher capacity and allied medical credentials.
The highly generalized format and techniques of Swedish massage, fringe massage and relaxation massage therapy do not meet the clinical needs of a medical or rehabilitation therapy environment. Lengthening the period of study within a training program does not address the need for a higher level of technique, clinical protocol, knowledge of the pathophysiological processes of connective tissue disease and disorders, and the application, formulation and delivery of sophisticated rehabilitation programs.
Medical massage therapy is emerging as a manual medicine system of treatment that does address the needs of a rehabilitation therapy environment. Medical massage therapy achieves this clinical criteria because:
Swedish or therapeutic massage employs generalized manual techniques such as gliding, kneading, striking, shaking, and friction. Medical massage utilizes these same movements as soft tissue pre-treatment preparation for the primary deep tissue and joint complex protocols that follow this general preparation. Medical massage deep tissue technique employs a relaxed hand technique referred to as the "soft hand." This hand technique allows deep tissue penetration without patient discomfort and without exacerbating the patient's condition. In addition, medical massage therapy utilizes patient anatomical positioning and soft tissue folding in order to reduce postural soft tissue tension and muscle contraction. Medical massage techniques combine manual therapy techniques directed at all connective tissue structures with joint mobilization techniques that "exercise" the deep internal joint complex tissues. These mobilization techniques, based on the normal physics of joint motion, include torque, shearing, accommodation and traction. The techniques of Cassel (osteopath) and Smith (naprapath) are also employed. The Cassel techniques include extremity shaking and release techniques; the Smith techniques involve the use of a bony lever and hand contact that move the joint and gently exercise and stimulate the ligaments of the joint.
Medical massage therapy is a highly specialized system of connective tissue rehabilitation based on theories and research regarding connective tissue healing and remodeling. This system of massage therapy recognizes that the joint complex and its attendant soft tissue structures, especially ligaments, are the primary sites of chronic pain and dysfunction, and that treatment of these structures must be directed at the soft tissue findings that result from diagnostic palpation. Treatment must be provided for the purpose of soft tissue and joint rehabilitation. In addition, therapeutic exercise, physiotherapeutic modalities, and patient education are combined in a treatment plan that identifies the appropriate frequency and duration of a therapy program. Medical massage therapy recognizes that clinical treatment for the goal of connective tissue rehabilitation must identify the cause of a problem and utilize direct manual technique to correct the cause of the problem.
All systems of manual and massage therapy share a common historical heritage. They are more than the mere sum of their parts - not simply "technique," but a synthesis of education, training, experience, dedication, humility, and intuition, expressed through the miraculous instrument, the human hand. Medical massage therapy is not so much a "new" approach to massage therapy as it is a "renewal" of the manual medicine practiced by many of the early European and Western medical pioneers of massage therapy.
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