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Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
December, 2010, Vol. 10, Issue 12
Pediatric Massage Study Finds Surprising Results
By Tracy Walton, LMT, MS
I had the great pleasure of attending the American Massage Therapy Association National Convention in Minneapolis this year, and hearing a panel discuss pediatric massage research. Among the presenters was Dr. Sean Phipps, a psychologist and researcher at St. Jude Children's Research Hospital in Memphis.He presented a large study of massage and humor therapy in children undergoing stem cell transplant (SCT).1 Stem cell transplant is typically used to treat certain types of cancer and blood diseases. It is a rigorous procedure, with multiple medical risks to the patient.
This is an important and useful study for a number of reasons:
I'll leave the explanation and importance of the first two points to the various resources in massage research literacy.2 Instead, I want to focus here on the last point, that the study observed NO effect from massage or humor therapy in pediatric SCT patients. The audience was understandably surprised, and some of us were stunned. What happened?
The study staff recruited 178 pediatric SCT patients. Because stem cell transplant is notoriously strong treatment, associated with high degrees of distress for patients and families, the study looked at both patient- and parent-targeted interventions. This was not the first time the group attempted research in this area; Previous, smaller studies had documented the feasibility and appeal of massage and humor therapy,3 and had even suggested some benefit to warrant this further study, which was a larger scale, NIH-funded controlled trial.
The patients, aged 6-18, were randomized into three arms. One was a child-targeted intervention composed of massage and humor therapy. Another group received the child-targeted intervention in addition to a parent-targeted intervention that involved massage and relaxation/imagery. The third group, the control group, received only standard medical care.
A standard massage routine was provided by professional massage therapists, with the intended dose set at three half-hour sessions per week for 4 weeks, beginning at 1 week before transplant. The actual average massage dose turned out to be 8.8 sessions over the course of the study, as timing and other logistics often affect the actual amount delivered. The researchers measured somatic distress, mood disturbance, length of hospitalization, the time to engraftment (for the transplant to "take") and the use of opioid pain relievers and antiemetics (antinausea drugs).
As stated above, the investigators found that massage therapy and humor therapy made no difference in any of the outcomes. The patients' experiences of SCT appeared to be unchanged by these two complementary therapies. Even the addition of the parent-targeted therapy, in which the designated parent received massage on the same schedule as the child, along with relaxation therapy, seemed to make no difference. In fact, Dr. Phipps showed graphs of the three groups that were almost identical. Changes in mood and distress measures did occur in all three groups over the course of 4 weeks, but they were typical ups and downs over the course of the procedure. During SCT, the mood and distress measures get worse before they get better, and the patterns were the same in all three groups.
There were no differences in the medical outcomes, either. The time to engraftment, length of hospital stay, and use of pain relievers and antiemetics were surprisingly similar across the three groups.
What Do We Make Of This?
The study authors admitted being surprised by the results, and even disappointed. One important quality in a research paper is humility, and the authors were quick to point out possible limitations in the study design: perhaps they weren't measuring exactly the right outcomes, or the timing of the measurements was not perfect. The age range of 6-18 years in their patient may have been too broad to fully standardize the treatments. They also report that the results of a single study--theirs--is not sufficient for firm conclusions. More studies, from additional researchers, are needed before we can determine whether to advise massage for this population.
One of the most potent observations in this paper, and in the talk that I heard, was that the standard medical care during SCT has improved much in the past years, and that patient distress is so well-managed that it is difficult to improve upon it with massage. In fact, levels of distress in the study sample were quite low to begin with, and throughout the study. While SCT-related distress still exists, it may be that standard medical care is already reducing it to the lowest levels possible, and massage cannot be expected to take it any further.
I was impressed by the care taken in this project, by the findings, and by the reflections of the investigator. I have a few of my own thoughts to add to discussion:
First, it is important for researchers to publish work like this, when the outcomes do not meet the researcher's hypothesis. If we reported only the "good" or "bad" news in massage research (a problem called publication bias), then it would hold back the science of massage, and take longer to learn its true impact. I hope that other massage therapy trade publications also report on these findings, as disappointing as they are, so that the news is balanced.
Second, as much as I might wish for massage to have an effect in this population, the science and my own wishful thinking are two separate things. Massage is powerful therapy, but it is unlikely to be a cure-all. If it really is true that massage has no significant effect on a given population, we need to know that. As a profession, it's important to know if massage is less effective in some populations than in others. If it is, we can direct our study and practice where we know it is effective. Perhaps other patient populations are more responsive to massage, or there are places where the medical management of a condition falls short, and massage could play a larger role. If so, perhaps we should focus our efforts there. This would not mean denying massage to people undergoing SCT. Instead, it would mean that we continue to study the impact of massage, learn where it's most effective, and make sure we act on that information.
Finally, I am interested in the massage design and dose. I have to ask, in this and other studies, whether the massage dose is sufficient to bring about a change? Do we need to schedule daily massage in some populations, so that after logistics have taken their toll, the participants end up receiving 4-5 sessions per week? If so, would 4-5 sessions per week be sufficient, or too much? Does scheduling massage at certain points compromise its effectiveness, and, instead, it should be provided on demand the way some pain medications are administered? Are certain massage strokes, or body areas of focus essential for massage to be effective?
As disappointing as these results were, the study offers an important contribution to the body of research. I am not ready to abandon massage of SCT patients, nor do the investigators suggest that we should. But the study asks good questions. I am grateful to the investigators for their care, expertise, and clear reporting. As good research, this study invites further reflection, discussion, and, of course, more research.
Click here for more information about Tracy Walton, LMT, MS.
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