resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Building Kidney Yang and Jing
Kidney yang, if we include mingmen fire, is the energy and heat source for the whole body. Jing is the essence of yang, and is stored in the kidney, extraordinary channels, and in the bone marrow, which in TCM also includes the brain.
A Very New Year: It's Time to Track
As we enter 2017, we find "affordable care" is not so affordable for many individuals. They are discovering what employers learned long ago: Health care is expensive – and keeps getting more expensive.
Change on the Horizon? New White House Spells Shift in Health Care Policy
On the morning after Election Day, many in our country were surprised to learn that not only did the Republican nominee win the White House, but also that the House of Representatives and the Senate remain under GOP control.
The Key to Recovery
Starting in the 1970s and developing over a decade of assessment and improvement, the South Bronx's Lincoln Recovery Center staff refined the method of using five basic ear-points, which became the NADA protocol for the treatment of addiction.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion.
What Are Prebiotics – and Why Should You Care? (Part 1)
In previous articles, I spoke about the different kinds of fiber and their effects, and the potential risks of taking probiotics without also consuming prebiotic soluble fiber (PSF) in foods and/or supplements [see August & October 2016 issues].
Case Study of Benign Hand Tremors
Patients without degenerative diseases causing tremors are often given the diagnosis of essential tremors, for which treatment options are limited to lifestyle changes and medications.
Increase Your Practice Income With Retail Products
With only so many hours in a day, there is a cap on the revenue an acupuncturist can generate by way of appointments. Once your appointment book is filled, you can't really add more without burning yourself out.
The Mysterious Divergent Channels
The divergent channels are among the most mysterious entities in all of Chinese medicine. They are rarely mentioned, lacking reference in modern TCM study, and rarely used within popular Chinese medical treatment.
Losing Your Mind? Try Coconut Oil
Alzheimer's disease (AD) is currently the 6th leading cause of death in America according to the CDC. It affects over 5 million Americans and 50 percent of nursing home residents (2014), and is projected to spike to 16 million by 2050.
Top 2017 Health & Fitness Trends
We really did sign up for a career of learning and development. Now that you have built a strong foundation of your manipulation skills, nutrition base, movement assessments and business knowledge, it's time to keep up with the American College of Sports Medicine's 2017 worldwide health and fitness trends.
MD-DC Affiliations Under Fire
I am George P. McAndrews, lawyer for the chiropractors in the Wilk, et al., v AMA, et al., antitrust suit that resulted in an injunction against the AMA and others, banning them from interfering in lawful professional relationships between medical physicians and doctors of chiropractic.
Your Patients With Cancer Need You
It was a chilly Minnesota morning in March 1999 when she asked to speak to me alone. My then-busy chiropractic practice wasn't built for much privacy, but I quickly scooted the 60-some-year-old, white-haired patient to my exam room, as the open adjusting area was buzzing with excitement.
An Education in Stroke Risk and Chiropractic
Dr. Steven Shoshany's ninth appearance on "The Dr. Oz Show" may prove to be his most significant, as he addressed questions related to the death of Katie May, who suffered two strokes in February 2016, hours after her third visit to a chiropractor for what she described in a Twitter post as a pinched nerve in her neck experienced during a photo shoot days earlier.
Scope of Chiropractic Practice: Time for Change?
The University of Bridgeport, College of Chiropractic Student Government Association sponsored a panel discussion on Oct. 25, 2016.
Acute Locked-Back Syndrome: Cause and Correction
As we all know, occasionally a patient will present with acute-onset low back pain with or without a precipitating incident. A distinguishing feature of the presentation is visible lateral antalgia, both standing and walking.
Scar Reduction With Acupuncture & Microneedling (Part 1)
Applied correctly, modern skin needling techniques can form part of a holistic treatment and incorporate the principles of Chinese medicine.
Clinical Outcomes & Safety for TCHM
The practice of Traditional Chinese Herbal Medicine (TCHM) may appear archaic to those who misunderstand the theories and principals that guide it. In fact, TCHM continues to evolve and new systems are consistently being discovered and applied within the tradition.
April, 2011, Vol. 11, Issue 04
Trends and Modalities: Are You Still Practicing Old School Techniques?
By James Waslaski
As an educator, it's critical to keep abreast of current research and to constantly challenge your belief systems. You may have read the popular article "Don't Get Married" (MT February 2008) written by a close friend and colleague Erik Dalton.1 In that piece, he cautioned manual therapists about getting too attached to trends and techniques for fear that new research findings may prove them totally wrong.Regardless of whether you are an educator, practicing therapist or both, keeping up-to-date with the latest information is essential to our profession; and in some cases, it will also keep old school techniques in the past where they belong.
I have spent six years writing a textbook (available this year) called Clinical Massage Therapy: A Structural Approach to Pain Management (Pearson Publishing). During that time, I've edited the information in that text hundreds of times based on the reviews of other manual therapists and the fact that many of my earlier thoughts on bodywork techniques have been proven, by recent clinical studies, to be flawed. Let me share some of the things I have taught in the past that, in light of new research, now seem embarrassingly inaccurate.
Old School Rule #1
Deep cross-fiber friction aligns scar tissue.
About 18 years ago, I wrote and taught that in the presence of a muscle-tendon strain, the appropriate therapy was to apply deep cross-fiber friction in one direction only for up to 6 minutes and then apply ice. The person I studied with made the claim that the act of deep cross-fiber friction had the ability to re-align the disorganized scar tissue. However, if you look at the disorganized fibers, several mistakes are apparent in this thought process.
Old School Rule #2
Clients presenting with chronic tendon pain due to overuse of the elbow, shoulder, knee, or Achilles tendon have tendonitis.
In 2000, Khan et al found no signs of inflammation in tissue biopsies from patients diagnosed with overuse syndromes such as tendonitis of the elbow, shoulder, patellar ligament and Achilles tendon - no lymphocytes, neutrophils or macrophages at a cellular level. Additionally, they observed no swelling, redness or inflammation on the surface level.4
In the absence of an inflammatory process, the more appropriate term to describe a muscle tendon strain is tendinosis. Khan and associates concluded that a majority of tendon pain could be resolved simply by reducing the load on the tendon or by restoring normal muscle resting length to opposing muscle groups. Once muscle balance is restored and the tendon is unloaded, the therapist must reevaluate the area via muscle resistance tests to isolate the strain. (Fig 3)
To more effectively soften and reorganize the cross-linked collagen matrix, I believe therapists need to gently apply multidirectional frictioning to the damaged area. (Fig. 4) Then, to eliminate the pain and restore pain-free movement from most overuse tendon injuries, techniques then include eccentric muscle contraction are helpful. (Fig. 5) Unfortunately, too many manual therapists are still applying aggressive and prolonged deep cross fiber frictioning to muscle-tendon strains and possibly turning tendinosis into tendonitis.
Old School Rule #3
Should we perform deep tissue or trigger point work to weak, inhibited muscles?
This particular old school teaching really concerns me. To make my point, I'd like to relate this to manual therapists doing trigger point or deep tissue work to weak, neurologically inhibited (overstretched) muscle groups, prior to treating the short tight muscle groups. For simplicity, let's first look at the short, contracted muscle groups doing the pulling and then we'll address the stretch-weakened antagonist muscles. In the majority of the people on the planet, the pectoralis major, pectoralis minor, and subscapularis are short and tight, causing the rhomboids, middle trapezius, and posterior rotator cuff muscles to become neurologically weak and inhibited due to eccentric loading.
When you start a client face up and lengthen the short, tight anterior muscle groups, you aid in relaxing the weak inhibited posterior shoulder stabilizers. Once the therapist manages to restore normal muscle resting lengths to the tight agonist muscle groups, it reciprocally turns down the noxious afferent stimuli and relieves many of the myofascial and neuromuscular pain patterns. However, the jury is still out on the trigger point part of this, but I have always gotten better results treating short, tight contracted muscle groups prior to treating weak, inhibited antagonists. (Figs 6-8)
In most of the population, I believe it's difficult to resolve trigger points (myofascial tender points) in the weak, inhibited rhomboids by starting a client face down and doing trigger point work. Since much of our pain comes from living in forward head flexed postures with medially rotated shoulders, starting a client face up often makes more sense. This assures that the majority of short flexor muscles groups are lengthened prior to working on weak, inhibited extensor muscle groups. This commonly seen distorted neuromyofascial postural pattern is illustrated in greater detail when you view Tom Myers' Anatomy Trains and in the upper and lower cross syndrome taught by Erik Dalton.
Medical Vs. Clinical Massage
In my own career, I started in the field of sports massage, and went on to learn more advanced work from some of the greatest pioneers and structural body workers in our industry. Orthopedic or clinical massage is now a total system rather than a single modality. That total system of assessments, special orthopedic testing, clinical reasoning, multidisciplinary and multimodality treatments, along with precise client self-care protocols will facilitate myoskeletal alignment and eliminate pain and injuries. It will also optimize athletic performance, aligning us with all other manual therapists for the best interest of each client. Having said that, the question arises: Is this sports massage, clinical massage, medical massage or are we simply talking about massage with intent to bring the body back into balance, facilitate healing, and eliminate pain?
I'll be writing an in-depth article on the subject of medical massage in an upcoming issue, but, for now, let's loosely define this commonly used name. I believe "medical massage" should be considered an umbrella term to include most forms of specific restorative and enhancement manual therapy techniques, particularly those directed at resolving a client's/patient's particular pain complaints. I chose to use the term "clinical massage" in the title of my book in order to honor and respect the many other modalities that have an amazing effect in changing medical outcomes i.e., cranial and visceral manipulation, myofascial release, lymphatic drainage, posturology, myoskeletal alignment, anatomy trains, structural integration, oriental bodywork and the list goes on. Even a good relaxing massage to reduce the stress that leads to many diseases and illnesses plays a critical role under the umbrella of medical massage.
The fact is, positive things begin to accelerate exponentially when therapists learn to blend multiple touch-therapy assessment and treatment modalities with functional retraining to better address our client's/patient's pain and injury conditions. Much more information will be shared in future articles about the scope and practice of medical and clinical massage and the positive attributes gleaned by combining various modalities in an evidence-based clinical practice.
Author Note: The material presented at the World Fascia Congresses is a good example of how quickly information about the "stuff we touch" changes. www.fasciacongress.org/2012
Click here for previous articles by James Waslaski.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.