resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
August, 2011, Vol. 11, Issue 08
Investigating the Physiology of Massage
By Massage Therapy Foundation Contributor
In this month's Massage Therapy Foundation Research Column, we are exploring how massage works on a physiological level. While massage has been shown to be effective in various settings - little is known about the mechanism of how massage produces its benefits.It is commonly thought that at least some of the effects of massage come from alleviating muscle tension. However, it has yet to be conclusively shown to reduce the underlying neural activity (tone) in the muscle. Who hasn't asked or been asked, "Where are you experiencing tension today?" as Langdon Roberts asks in his article published in the March 2011 issue of the open access International Journal of Therapeutic Massage and Bodywork.
Langdon Roberts, MA, CMT, of the Center for Transformational Neurophysiology in Soquel, Calif., investigated this issue in a study entitled "Pressure Application and Resting EMG." Using surface electromyography (EMG) to measure muscle activity, Roberts hoped to quantify the exact change in muscle activity during two types of massage - light, medium and deep massage applied in the order of increasing pressure (IP) or decreasing pressure (DP). In this study, the electrical activity generated was measured in the m. rectus femoris of the left legs of twenty-five individuals. Roberts hypothesized that muscle activity would be lower after either massage, with IP resulting in significantly lower EMG activity than DP.
Roberts writes, "[When] Goldberg et al. compared light and deep petrissage to the triceps surae [...] deep massage produced a greater reduction in the H-reflex, an electrical analog of the stretch reflex." The H-reflex (Hoffman reflex) is a measure of spinal cord excitability. Roberts cites other research that appears to link a reduction in H-reflex and massage, although he notes H-reflex hasn't been linked to pain reduction or any other known benefits of massage.
Roberts used a clinical crossover design in this study, meaning all 25 individuals received both IP and DP massage, with at least four weeks in between. The ethics of Roberts' study protocol were approved by an internal review board at the Muscular Therapy Institute in Cambridge, Mass. The massage setup was simple, with electromyography electrodes placed proximally and distally to the left rectus femoris, at its musculotendinous junctions. Each massage session was composed of three strokes for each level of pressure to each leg's rectus femoris, beginning with the left leg.
Roberts solicited the three levels of pressure as: "light, but not insubstantial," "moderate" and "as deep as possible without causing pain or a sensation of increased muscle tension." Each slow stroke was performed in a toward-proximal direction and lasted for 15 seconds. Two minutes elapsed between each pressure level. The massage therapist wore thumbtip pressure sensors and applied the strokes using adjacent thumbs. These gloved sensors showed that people in the IP and DP group preferred different objective vs. subjective pressure levels as indicated in a repeated-measures ANOVA [p<0.02]. Further study may show that subjects who receive deep pressure first require a deeper objective pressure to get to a pressure subjectively on the border of pain. In other words, clients may be able to withstand deeper pressure when it is used first. Unfortunately, equipment malfunctions prevented a test of this hypothesis in this study; only 14 subjects had "reliable" data available for statistical analysis.
The EMG results, while surprising, confirm many massage therapists' intuition. Using repeated-measures ANOVA on a group with all DP data, Roberts found, "EMG varied significantly across the four time points [p < 0.03]." In the DP data the application of deep pressure without previous massage caused a sudden increase in muscle activity, which diminished when lighter pressure was later used. This was not the case with the IP group, where "IP data indicates that EMG did not vary significantly across the four times points [p = 0.71]." These results did not differ between the IP-first and DP-first groups [p = 0.30 & p = 0.38].
Although the individuals studied were mostly (>80%) women, this is typically true about the population that seeks massage therapy as well. Another limitation of the study is that different muscles may show different EMG results, since Roberts cites studies that show "a reduction of EMG activity after massage [...] consistently found only in the frontalis muscle." Notably, the massage in this study was applied only to the rectus femoris muscles that were already relaxed, not in pain or otherwise uncomfortable.
This study validates the use of EMG as a tool for investigating the physiological basis of massage. One potential subject for further study includes a comparison of the EMG methods used here - a MEDAC Sys/3 physiological monitor. Roberts recommends a system of "counting repeated minima during each collection period," which he suggests as superior to "counting mean values" because of the commonplace nature of EMG artifacts or false readings.
How can you apply the results of this study to your own practice? If your treatment goal is to reduce or minimize EMG activity, then you should begin with light pressure and gradually increase your pressure during effleurage strokes, especially on the large muscles of the quadriceps. Unfortunately, these results are limited to asymptomatic rectus femoris muscles studied in a small group of people by a single therapist. Further research may show that a DP style of massage consistently causes a sudden spike in EMG activity, and could relate that to patient outcomes. Research has not shown a link between EMG activity and subjective tension. According to Roberts, "Carlson et al. [found] no relationship between perceived tension and EMG activity in clients with muscle pain or in pain-free subjects." Roberts suggests it is likely that "multiple modulating factors" could be at play in the EMG results seen here.
The research reported here was funded by the Massage Therapy Foundation, the same foundation that supports this column. We hope Roberts' and others' research will elucidate to what extent endorphins, reflex pathways, and/or the "freeing of nociceptive or mechanoreceptive nerve endings" contribute to the physiological benefits of massage. For more information on the MTF, visit our website at www.massagetherapyfoundation.org/.
Source: Roberts, L. (2011). Effects of Patterns of Pressure Application on Resting Electromyography During Massage. International Journal Of Therapeutic Massage & Bodywork: Research, Education, & Practice, 4(1). Retrieved from www.ijtmb.org/index.php/ijtmb/article/view/25/154
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