It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
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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