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Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
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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