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Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
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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