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Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
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.
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.
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.
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.
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.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
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.
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.
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.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
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.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
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.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
June 14, 2004
Massage Technique: Can Yours Withstand the Test of Research?
By Gregory T. Lawton, DN, DC
The massage profession is represented by a rich diversity of massage techniques that are the product of the ideas, concepts and theories of massage practitioners over many decades and centuries.After years of practicing in the shadows of health care, massage therapy and other forms of traditional health care, such as acupuncture and herbal medicine, are gaining wide and enthusiastic acceptance within the public and professional arena.
The massage profession is composed of many different systems of therapy and practice. Some massage systems are strictly esoteric and others label themselves as therapeutic, sports, orthopedic, clinical or medical. Massage will always be valued and appreciated for its nurturing and comforting effects on the human body, mind and spirit. It is in the area of clinical claims for effectiveness in the treatment of human disease and pathology that massage will have to prove its claims of safety and efficacy, and pay its dues in order to gain the respect of the public and other health care professions. One of the stepping stones to this respect and acceptance is research.
Many massage therapists would be surprised to find out that a great deal of research on massage therapy and it effects in areas that directly relate to the practice of massage, has already been completed and is easily available. There is, indeed, a vast body of this research already in existence. Research has been performed on specific massage techniques and their effectiveness, and research has been performed that strongly relates to the practice of massage. This includes research in the fields of chiropractic, manual medicine, biomechanics, physical and occupational therapy, osteopathy and psychology. This research is available in many professional journals, on the Internet and in books written for physicians and professional members of the allied medical community. Very little of this research has found its way into the massage community. Much of the research that has been presented to the massage community is often outdated, or has, unfortunately, been misinterpreted.
It is true that more research needs to be performed and that this research needs to be directed at the specific techniques and methods used by well-trained practicing senior massage therapists. Research that has been performed in the U.S. has been particularly poor. Techniques that are studied are often not performed by a trained massage therapist or the techniques that are used are too general and non-specific. This situation is, however, not true of the worldwide research community, and excellent studies have been performed in Europe and specifically in the Scandinavian counties. How is your Swedish?
Why do we need research? Well maybe you don't. In Sweden, for example, research needs to be performed on any system or technique that will be used to treat human pathology or disease, and that will be covered by its national health care system. Incidentally, the Swedish government will pay for the research; if the result is positive, it will pay for the massage treatment. If you don't practice clinical, medical, orthopedic, or sports massage, but rather practice from a nonclinical approach, you probably don't see what all the fuss is about. Most countries that have a long tradition of providing access to massage therapy as a treatment for human disease have established a basic ethical standard of care. That standard is based on research and proven effectiveness.
This article is written about systems and forms of massage therapy that lay direct claim to treating human disease and disorders. Within the many and diverse systems and forms that claim this effect, there are two distinct divisions that classify basic massage techniques:
Massage has a long history of empirical evidence that supports its claims to achieving direct physical effects in the body's connective tissue structures. This claim is also supported by decades of research that comes out of several related manual therapy disciplines. Any practicing massage therapist can easily tell you about the effectiveness of massage therapy for a wide array of physical conditions and disorders. Ongoing research and study will assist the practicing massage therapist in understanding which techniques are the most effective in the treatment of specific musculoskeletal conditions. Research will help us write better massage textbooks and train better massage therapists for the future.
Recent research and study that has specifically investigated common massage techniques such as compression, stroking, kneading, and percussion has demonstrated the following:
The direct effects of massage establishes massage therapy as facilitating many very beneficial effects on pain management and reduction, and in the promotion of connective tissue healing following trauma or injury. If this was all we knew about the beneficial effects of massage it would be enough, but there is much more.
Massage therapy used in clinical, medical, orthopedic, and sports therapy aspires to a higher research standard than has been the norm in the general massage field. Over the last 50 years of massage history massage therapists, manual therapists, osteopaths, and chiropractors have postulated a large array of physiological theories regarding how the body works and particularly how it responds to manual stimulation. In any field some of these ideas are good, and some are bad. Some have been researched, but many have not, at least not in any generally accepted sense. Some of these ideas, concepts, and theories have been disproved. A large number of these erroneous ideas, concepts, and theories are a common component of current massage education and practice. Some of the proponents of these erroneous theoretical systems of massage question the need for massage research while at the same time laying claim to flawed research upon which they have built their incorrect concepts based on non physiological processes in the body.
There are several commonly promoted and widely accepted systems of massage technique that are based on the theory of reflex control of muscle activity by a golgi tendon organ (GTO) as a proprioceptor. First of all the word proprioceptor, which repeatedly appears in most massage textbooks and articles on massage has not been an accepted scientific term since the early 1900's. The correct word is mechanoreceptor and the mechanoreceptors include the GTO, muscle spindles, and other joint and tissue receptors. The entire theory of the GTO as having peripheral motor control over muscle activity is an erroneous concept and so any massage system or technique that is based on this understanding either doesn't work, or doesn't work as claimed.
Some massage therapists and promoters of the GTO theories of reflex control over muscle activity confuse whether the GTO is stimulated by stretch or contraction, and in several massage books they vascillate between stretch and contraction. Actually the GTO is a very excellent reporter of dynamic contraction in muscle tissue, but alas it only reports, it does not control. The control mechanisms are very complex and they are located in the central nervous system (CNS), the brain is the boss not the GTO. This process is called proprioception and it is a part of the somatosensory system which is managed by the brain. Additionally, the GTO is only one of the varied biological sensors that reports information on connective tissue tension and position. All of these mechanoreceptors work together to provide the CNS with the information that it needs.
One popular author of the erroneous GTO theory actually states in his book that tension in the muscle will cause the GTO to order cessation of muscle activity. What a surprise to my friends who are bodybuilders and powerlifters. I guess the next time that I bench press 200 pounds I better be careful, because my GTO's will measure the increased muscle tension and cause cessation of the activity. I will also be in trouble the next time I go rock climbing in Sedona, imagine what will happen to me as I am hanging from my finger tips from a rock ledge and my GTO's decide to stop my muscles from contracting. Obviously, central motor control of muscle activity is a much more powerful mechanism than the perpherial receptors, like the GTO's.
The next step in these erroneous and non physiological (can we say physiologically incorrect?) theories is the idea that in a few minutes of treatment time, by resisting patient intentional movement (isometric contraction) or by only partial resisting movement (isotonic contraction) the therapist can "reset" the "proprioceptors" (wrong word) . There are several massage systems, including Muscle Energy Technique, that use this theoretical approach to joint rehabilitation therapy, none of which have been found to work by the non physiological processes that they claim. There are several important basic reasons for this:
Contained with these erroneous theories of physiological function is the idea that the tendon reflex, peripheral "proprioceptors" (mechanoreceptors), control a protective mechanism against over stretching of a muscle. Actually the protective mechanism that protects against over stretching is pain, or the nociceptors. Relaxed, pain free, muscles can be stretched extensively without producing a protective contraction. Consider yoga! If the "proprioceptor" theory of protective inhibition was correct then the peripherally mediated contraction would produce increased strain in the muscle and tendon and result in injury to the tissue.
If these ideas, concepts, and theories don't work in real life, how are they going to work on the treatment table?
This information, the research and studies, is a common and readily available part of the scientific research of physiology, neurology, and occupational therapy. Much of the current information on learning behaviors in connective tissue is the result of collaboration between sociologists and occupational therapists. The Scandinavian manual therapists and researchers in the field of manual medicine have used this information to guide their use of appropriate massage technique. Much of this research regarding the GTO and tendon reflex has been available in the field for the last 20 years. It probably would not be incorrect to suggest that well over 90 percent of the massage therapists currently in training, and we train about 47,000 massage therapists per year, are still being taught these non physiological and erroneous models of body function and therapy. This training has in effect become "massage dogma". Unfortunately, many massage therapists now have to "unlearn" much of what they have come to accept as being true about the relationship of body physiology and neurology as applied to massage technique. These erroneous concepts can be very hard to dislodge once they have become embedded in the minds and practices of massage therapists. Many massage therapists have received this kind of information and training as "advanced certification".
Massage techniques that have been shown to work effectively in the stimulation of mechanoreceptors and neurological learning processes include:
The above techniques have been found in studies to be effective in the general treatment of conditions of muscle spasm and increased motor tone. These techniques are especially effective in the treatment of abnormal neurological conditions that have resulted from injury or damage to the central nervous system, such as post stroke. These techniques, that involve gentle passive repetitive joint movement and light stroking, compression or percussion, reduce abnormal motor tone in muscle and assist the patient in acquiring new skills in muscle relaxation and utilization. These techniques do not reestablish the neurological norm. The norm has been lost and will not be reestablished. What does occur is the development of coping mechanisms, while they are not normal, they do become functional behaviors.
The massage therapist who is using myofasical release technique combined with muscle energy technique on a post stroke patient for the purposes of breaking down muscle contraction and reflexively relaxing spastic muscle, is doing more harm than good. The myofascial release technique overstimulates tissue receptors and provokes the pain receptors (nociceptors). This results in hypersensitivity and increased pain and spasticity in the affected body region. Subjecting the patient to exercises that involve active contraction against the therapist's resistance only increases muscle contraction and damage. The correct methods of therapy for patients with abnormal CNS conditions involves:
Another issue that many massage therapists are confused about is the definition of muscle tone and motor tone. Most massage textbooks and schools teach that there is a "resting muscle tone" or that "abnormal" muscle tone results from neurological activity or stimulation. This is not correct. Muscle tone is simply muscle bulk, and nothing more. Muscle tone is fluid in the muscle and the connective tissue that composes the muscle. It is like holding a raw chicken breast in your hand. When the muscle is placed in a completely relaxed position and the therapist palpates the muscle, they are palpating muscle bulk. The tension or resistance in the relaxed muscle can change with connective tissue infiltration such as fibrosis or with increased fluid build up, say after exercise or during inflammation due to injury of the muscle. Motor tone is a result of neurological or motor neuron stimulation to the muscle. Motor tone varies, increases or decreases in direct relationship to motor neuron activity, normal or abnormal. A resting or relaxed muscle is "neurologically silent" and there is no resting motor tone in normal circumstances.
Many massage therapists fail to place a muscle in a completely relaxed, neutral, or "folded" position and they often attempt to evaluate "muscle tone" in a contracted or eccentrically contracted state. Contracted muscle is neurologically active and does have motor tone. An example of this is a patient placed supine on the massage table with their arms hanging freely over the sides of the table. The therapist then palpates the eccentrically contracted posterior shoulder muscles. The therapist is actually palpating active motor tone, not resting muscle tone. They are palpating active muscle contraction and not muscle bulk or connective tissue and fluid accumulation. This improperly applied procedure of course results in erroneous information regarding muscle tightness and shortness and will most likely lead to improper and unnecessary treatment. Additionally, it is very difficult to treat and to relax a muscle that is being treated while it is in a state of active contraction due to improper positioning on the table.
The facts, ideas and concepts in this article are presented for the purpose of assisting the practicing massage therapist or massage instructor in understanding the science behind the art of massage. Many massage therapists and massage educators need to update their training and practice skills to include new understandings about how the body functions and how massage technique might more effectively assist the therapist in their role of patient treatment and care. Knowledge, and the ongoing search for it, is a process and not an event. Just as some massage theories and techniques are now known to be outdated or ineffective, new findings have presented new methods and techniques, and undoubtedly this process of change and discovery will continue. Rather than being distressed or frightened by this vital process of growth, the massage therapist should welcome it and the benefits that it will bring to their practice of massage and their ability to more effectively serve the health care needs of their patients.
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