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Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Talking to Patients About Medial Branch Neurotomy (Part 2)
Even when lumbar facet denervation (medial branch neurotomy) is successful, relief is rarely complete or permanent. Smuck, et al., reviewed 16 articles and found the average duration of >50 percent pain relief for an initial procedure was nine months.
Teach Your Patients About External Healing Applications
Since the skin is the body's largest organ, and is able to respond to both internal and external stimulations, communicate sensations to the brain, protect the body, breathe and even excrete toxins, it can be an excellent source of healing.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Make Every Day Mother's Day
May is a special month for many reasons. After a long, harsh winter, spring is at last in full swing. Memorial Day helps us honor those who have fought and fallen in the name of freedom.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
If Your Pro-Chiropractic Governor Resigned, Would You Be Prepared?
John Kitzhaber, MD, recently re-elected to a historic fourth term as Oregon governor, has resigned among alleged ethics violations by his fiancée' and first lady, Cylvia Hayes. I developed a personal friendship with John and consider him a good friend.
Trouble in the Wellness Waters?
Call me old-fashioned, paranoid or just old, but I do remember graduating from chiropractic college in the late '70s in the midst of the Wilk v AMA lawsuit.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Apple Takes a Bite Out of Research
The more than 700 million iPhone users have just been given the opportunity to "do their part to advance medical research."
Functional Impingement of the Hip (Part 2): Rehab Exercises
I find functionally impinged hips that don't move properly on so many of my patients. (See part 1 of this article for a description of the condition.)
News in Brief
Dr. Frank Nicchi Receives Award at ACC-RAC; Sherman College Expands International Influence.
December, 2005, Vol. 05, Issue 12
By Keith Eric Grant, PhD, NCTMB
In a previous column, I touched on medical applications of massage that appeared in the indexed medical literature from 1997 to the present. Of 213 instances of medical goals addressed by massage, 155 (73%) were systemic rather than tissue-specific (clinical/orthopedic) interventions. Systemic treatment goals included increased well-being, stress and pain management, and improvements in self-image. These "systemic" effects of massage also are well-represented in the research reported by Tiffany Fields and the Touch Research Institutes (TRI).5 The TRI home page highlights observations that massage therapy: facilitates weight gain in preterm infants, reduces stress hormones, alleviates depressive symptoms, reduces pain, improves immune function and alters EEG in the direction of heightened awareness.5 With the above observations in hand, it seems time to consider mechanisms for the effectiveness of massage.
Tissue specific interventions (TSIs), while requiring understanding in anatomy and movement to implement effectively, are simpler conceptually. TSIs largely can be understood by reduction to specifics. The practitioner needs to be able to listen to client history, assess active and passive range of motion limitations, look-up and implement special orthopedic tests as needed, and thus gain a working hypothesis of the location, extent and nature of injured tissue i.e. the "lesion" resulting in pain or limitation. I differentiate active and passive range of motion limitations because they differentiate between pain felt in a musculotendinous unit when it's actively contracting and pain produced in ligaments, joint capsules and antagonist muscles when they are passively stretched. I note "looking up" special tests because I am a believer in having and knowing how to use information resources rather than in memorizing everything in sight (or reach). Procedures frequently used will be memorized. I define the result of assessment as a "working hypothesis" to clarify that it's not a medical diagnosis.
With TSIs, the techniques follow from assessment and isolation of the lesion(s). Tendinosis on tendinous attachments benefits from the stimulation of inflammation by local friction.1,2 Adhesions between fascial layers release under slow separating pressure. Trigger points succumb to ischemic pressure combined with various methods to lengthen the affected tissue. Muscle hypertension can be lowered by methods of positional release and post-isometric relaxation. The assessments and treatment might be intricate, but they are not inherently complex in the sense that we can conceptually connect the treatment goals and the intervention.
Understanding how non-tissue-specific touch affects the state of our human systems has not been so easy. We are able to record the effects, as has the Touch Research Institutes, but we haven't had a sound mechanism to explain them. My opening quote from Ashley Montagu motivates why touch would be expected to have profound effects on us, but it, too, stops short of mechanism. The answer, however, is starting to take shape in diverse venues of science and mathematics.
Over the last two decades or so, a new area of research has evolved. There are systems in which important properties lie, not in the individual parts alone, but in the interaction and communication between the parts. These properties have become known as "emergent properties," be cause they literally emerge from the complexity of interactions.6 In 1984, the Santa Fe Institute was founded specifically to study such complex systems.4 The April 2, 1999 issue of the journal Science was devoted to interdisciplinary viewpoints on research in complexity. These included papers on "Complexity and the Nervous System," and "Complexity in Biological Signaling Systems." Numerous papers and books have come out of studies of things describable as "information networks," including studies on organization spontaneously emerging in the structure of the Internet. We slowly are gaining the tools and the understanding that seemingly simple appearances can arise out of the complexity of interactions. We also are finding understanding that such systems can have multiple stable states and flip between them depending on input from outside.
Thus, we come to the human body as a system of systems a system with neurological, chemical, immune, emotional and sensory interactions all communicating. Sensory input includes touch in a big way. We come back to the observations of TRI and Ashley Montagu, with the understanding of massage and touch as a major input to a complex system. We don't understand the details, but we understand the basis for touch to create profound changes in the homeostasis of the human system. There are important structures of the human body that are not physical; they exist only in the fluid interchange of information within the living system.
In the end, it's not the complexity of the touch being done, but the complexity of the human system being touched that is most profound. Someday, we might be able to model the complexity of neurological-chemical-emotional-sensory interactions to determine patterns of sensory input that are most effective at inducing positive change. We still are far away in the infancy of such concepts. The best tool we have to bring to bear today is the equal complexity of the observational instrument known as the human practitioner. The human ability to learn from practice and observation and then to react in real-time to sensory input remains unmatched. We are slow at consciously processing input, but rapid at "unconsciously" matching patterns. There is great value in being able to initiate a simple touch, judge the response and adjust our input toward assisting the client's system toward a better place. We've known this intuitively for a good while. We are just beginning to develop the scientific finesse to explain it.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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