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Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
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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