resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Tribute to Richard D. Yennie, DC (1928-2013)
It was with sadness that I read the obituary of Dr. Richard Yennie in the Oct. 20, 2013 Kansas City Star. However, reading it also brought reflection and warm memories, as he was a close family friend of my grandparents, Cleveland College founders Drs. Ruth and C.S. Cleveland Sr.; and my parents, Drs. Mildred and Carl Cleveland Jr.
Promoting Acupuncture with Acupressure Demonstrations
Dan and his wife Marla were admiring the beautiful bouquet of flowers at our booth at the Business Expo when our receptionist asked him if he knew anyone who had tried acupuncture.
Managing a High Protein Diet
One of the most common clinical presentations in today's clinic is patients following a high protein diet. It seems that every year a new version of a high protein diet appears promising weight loss and physical transformation.
Acupuncture & Substance Abuse Rehabilitation
One of the most rapidly changing areas of healthcare is that of addiction medicine. Advances in brain imaging technology have allowed doctors and scientists to understand addiction, and recovery from addictive disorders, at the level of the individual neuron in the brain.
The Newest Public-Health Epidemic: Sitting Too Much, Moving Too Little
In my last column, I wrote about sitting versus standing at work. ("Sit or Stand? Strategies to Improve Workplace Health and Reduce Disease," Oct. 1 DC) I wrote the article from the perspective of an ergonomist.
Facial Rejuvenation: The Key to Exceptional Results
Acupuncturists make the best detectives. I know this first hand because I'm an acupuncturist and a private investigator and in both professions, there is a need to dig deep to solve the mystery.
PCOM Symposium Celebrates 25 Years
Acupuncture and Oriental medicine practitioners and students, as well as providers representing various other health care disciplines, flocked to San Diego's Catamaran Resort Hotel to attend the PCOM Annual Symposium on Oct. 24-27.
Does Copper in Your Multivitamin Cause Dementia?
For the past year or more, I have been asked about whether it is safe to take multivitamins with copper because of a fear that is apparently spreading. The fear is that 1-2 mg of copper in multivitamins supposedly causes dementia and/or Alzheimer's disease.
German Auricular Acupuncture: Effective For Your Patients
Auricular medicine as developed by Western medical doctors in Europe is a complete modality of diagnosis and treatment. Unlike body acupuncture, auricular acupuncture is treating the central nervous system rather than meridians.
The Lateral Subsystem and Lower Extremity Pain
Human locomotion is an incredible demonstration of muscle activation, timing, sequencing and patterning. The very idea that we can stand upright and put one foot in front of the other to get from point A to point B without falling down is miraculous.
Acupuncture In Haiti: Aid that Works
I recently returned from Haiti. So many people ask whether Haiti has recovered since the earthquake of January, 2010. Once you've been to Haiti, you would never ask that question. It doesn't make any sense.
Breathing Techniques To Resolve Patient Issues
When a patient of mine who has practiced yoga for nearly 30 years, told me that she was experiencing panic attacks, I was surprised. "After so many years of training, can't you turn them off?" I asked. "I do turn them off, but only temporarily," she replied.
50 Million Opportunities
Toca! Tira! Golasso! While you may not recognize these words ("Touch! Shoot! Goal!"), I hear them often.
Studies: Acupuncture Effective For Depression
Many people suffering from depression can find a natural and effective way to treat their symptoms with acupuncture, according to the latest study.
Continuing Education Showdown: Online Learning vs. In-Person Seminars
Many state TCM and acupuncture regulatory bodies and associations are interfering with the success of their members by limiting the number of continuing education credit hours they can earn online.
We Get Letters & E-Mail
Change: Healthy and Inevitable; Our Scope of Practice Needs to Change; Chiropractic Physicians Deserve to Be Accurately Informed.
Acupuncture: The Key and Future of High Sports Performance
Acupuncture is commonly utilized in the intervention of pain and has also been gaining popularity in sports medicine. Athletes are treated with acupuncture for the relief of soft tissue injuries such as sprains, muscle strains, and tendonitis.
Leaving a Vision of the Future Behind
Jeff Nelson, president / chief executive officer of Northwestern Health Sciences University since April, died suddenly on Oct. 22 as the result of a gunshot wound.
21st Century Marketing: Five Ways to Use Social Networks as a Customer-Service Tool
As the popularity of social networks grows among businesses and professionals, customers' expectations about how they will be served through these networks continue to evolve.
Partnerships Leverage Power for Our Profession
While there are many recognized benefits and advantages to developing partnerships between organizations, the main reason why partnerships are established is relatively simple: There is added value in working together for a common cause or purpose.
Sports Media Legend Joins the TIPS Team
The Foundation for Chiropractic Progress developed "Athletic TIPS" (Towards Injury Prevention in Sports) in an effort to address the growing concern of sports injuries.
Acupuncture Today Continues To See Unprecedented Growth
For the past decade, the profession has seen steady growth in stature with legislators and the general public. The growing presence of the profession has been directly reflected in the growth of our publication.
Advancing the Primary Spine Practitioner
A large New York Blue Cross / Blue Shield plan hosted the formal inaugural training program for primary spine practitioners (PSP) on Sept. 28-29, 2013.
Unlocking Secrets of the Pelvis (Pt. 3)
In part 1 of this series [Aug. 15 issue], we began to identify the many asymmetries human beings are all born with and detail how these asymmetries, when they become excessive or unchecked, can create a cascade of imbalance in every system of our body, resulting in dysfunction, pain, degeneration and eventually disease.
Educating the Growing Hispanic Population About the Value of Chiropractic Care
Chiropractic was given the spotlight on the largest and highest-rated Hispanic television network in the U.S., Univision.
Electric Qigong: An Ancient Therapy Evolves
Recently in a small, dimly lit treatment room in downtown Taipei, Wesley Chen instructed his patient to lie down. A frayed wire, which he wrapped around a small piece of metal, is now plugged in.
Peer Points: In The Business of Herbs
When it comes to herbs, acupuncturist Cathy Margolin wants her patients and customers to know she is the expert they need. In order to do this, Margolin has studied the marketplace and incorporated key business lessons to build an herbal company that sells and markets herbs to the masses who may be skeptics.
March, 2012, Vol. 12, Issue 03
Massage Therapy and Joint Mobilization
By Joseph E. Muscolino, DC
Massage therapy involves a number of treatment tools that can be employed for a variety of purposes. Massage can be done to decrease stress, improve local fluid circulation, create energetic balancing or simply provide touch.Perhaps the greatest advance for massage therapy, though, has been the acceptance of clinical orthopedic massage in the world of complementary/integrative health.
Clinical orthopedic massage is done with the intent toward healing a specific musculoskeletal condition. Toward this end, massage therapy education includes science education, the major focus of which is learning muscles. Indeed, massage therapists often know their muscles better than many physicians. In the absence of true muscle doctors in Western medicine, massage therapists have filled this void and become muscle therapists; and usually excellent ones at that.
Muscles and Fascia
If you ask most orthopedic massage therapists what their intent and goal is when working on a client, they will usually describe a muscle or group of muscles that they want to manipulate and loosen. Certainly, tight musculature is likely one of the most common, if not the most common, presenting complaint of clients. However, with the increased awareness of fascial tissues (both the understanding of fascial adhesions and the concept of fascial contraction, as well as the understanding of the fascial links between muscles of a myofascial meridian), some of the focus of massage therapy is being shifted away from the muscles themselves toward fascia. Although the pendulum should not swing too far away from musculature, it is important that a greater understanding and focus on fascia occurs so that we can have a more balanced approach to treating all soft tissues. By encompassing the fascial tissues into the treatment paradigm, massage therapists can broaden their domain to define themselves not only as muscle therapists but rather as myofascial therapists.
Defining the scope of massage therapy in this way is crucially important. It is not just inflexible muscles that can decrease mobility, limit a client's function, and cause discomfort and pain. All inflexible taut soft tissues can do this, whether they are muscles, tendons, broad fascial planes between and around musculature, ligaments or even joint capsules. In this context, the role of massage therapy can be understood to manipulate all soft tissues.
Joint Capsules and Joint Manipulation
Massage therapists can and should pay attention to the flexibility/tautness of all soft tissues, including joint capsules and other deeply seated intrinsic ligaments. These deeper fascial structures connect and provide stability to the bones of a joint. However, if joint capsules become taut, often due to the accumulation of fascial adhesions over time, the joint will lose its mobility. The province of loosening joint capsules is usually left to chiropractic and osteopathic joint manipulation. With the use of high velocity, short lever arm manipulation (a fast thrust that is implemented over a short range of motion), called an adjustment, chiropractors and osteopaths stretch joint capsules, thereby increasing the joint's range of motion, and therefore the client's mobility.
Muscles and Joints - Chicken and Egg
Given that a major goal of clinical orthopedic work is to increase the client's mobility, it is important that both tight musculature and taut joint capsules are treated. Indeed, tight muscles and taut joint capsules can be looked at as the proverbial chicken and egg. If tight muscles are loosened with massage, the remaining taut joint capsules will still decrease joint motion; and this decreased motion will eventually cause the muscles to tighten again. If, on the other hand, the client has a chiropractic adjustment to loosen the joint capsule, but the muscles are not loosened, these tight muscles will decrease the joint's range of motion, ultimately leading to the joint capsule becoming taut again. For this reason, it is critically important that muscles and joints are both addressed. This is why chiropractors and massage therapists so often work together. Marrying joint adjustments with massage soft tissue manipulation ideally complement each other, addressing both the chicken and the egg.
Chiropractic and Massage
When chiropractors and massage therapists practice together, the order in which their work is performed can matter. Many chiropractors choose to have the massage therapist work on the patient/client after the adjustment is done. However, this decision is often motivated more by ease of schedule and patient flow than by optimal treatment protocol. Given that an adjustment takes only a couple of minutes, but massage is performed for anywhere from 15 minutes to an hour, it is often easier for the chiropractor to adjust all of his/her patients and then leave them for the massage therapists to work on.
However, for most clients, it is more beneficial to have the massage done first. An adjustment can be performed more gently when the client's musculature and other fascial tissues have already been loosened. This is important because, if an adjustment is performed too forcefully, not only might it be uncomfortable for the patient, but also there is an increased chance that it will trigger a muscle spindle (stretch) reflex that could then result in increased muscle spasming. The more gentle the adjustment, the less likely spasming will occur and the more comfortable it will be. Further, if the muscles and other fascial tissues are loosened first, the joint will release more fully, resulting in a more successful adjustment. For this reason, it is usually preferable to have the adjustment follow the massage, not precede it. When partnering with a chiropractor, it is valuable to discuss these ideas and determine how to best work for the benefit of your patients/clients.
Massage Therapy Joint Mobilization
Massage therapists who do not partner with a chiropractor can still do valuable work to address taut joint capsules through joint mobilization. Joint mobilization is performed by bringing a joint slowly through a small and precise range of motion. Joint mobilization is similar to chiropractic manipulation in that it is performed through a short range of motion and focuses on loosening deeper intrinsic ligaments and joint capsules. However, the crucial difference between a chiropractic joint manipulation/adjustment and joint mobilization is that joint mobilization is performed slowly and never involves a fast thrust.
Joint Mobilization of the Neck
In Figure 1, we see that the therapist uses one hand to contact the lower vertebra (C6). Three contact options are shown: the thumb, finger pads, and the radial side of the index finger. In each case, the contact is made on the facet (articular process) of the vertebra, approximately halfway between the spinous process and the transverse process (Figure 2). The facets form a broad smooth surface that is a comfortable contact for the client (contacting the transverse processes would be extremely uncomfortable for the client). The therapist's other hand must hold and move the client's head. As a rule, this hand is placed on the other side of the head from the hand that is contacting the vertebra. It must be placed under the center of weight of the client's head so that the head is easily balanced in the hand. Care must be taken not to cup over the client's ear or press on their mandible. Now, securely pinning the vertebra below (C6), bring the client's head and upper cervical spine (C1-C5) around the pinned vertebra until the end of passive range of motion is reached and tension is felt at the C5-6 joint (Figure 3).
Now the actual joint mobilization can be performed in one of three ways:
The position of joint mobilization is held for less than one second and then released. This procedure is usually repeated a few times at that level and then performed at the other joint levels of the neck. After mobilizing into right lateral flexion, left lateral flexion is done, as well as other ranges of motion bilaterally. The result is that the entire neck is mobilized in all ranges of motion.
Effective and thorough clinical orthopedic work requires increasing flexibility of not only muscles and superficial/intermediate fascial tissues, but also the deeper intrinsic ligaments and capsules of joints. Massage strokes are ideal for remedying tightness in the superficial and intermediate tissues. Supplementing this, stretching can be invaluable in increasing flexibility of most soft tissues. However, to truly address tautness/adhesions in the deepest fascial structures of the joints, intrinsic ligaments and joint capsules, joints manipulation is necessary. Although joint mobilization technique can take time and practice to learn well, the benefit to your clients and to your practice makes the effort well worthwhile.
Joseph E. Muscolino, DC, has been a massage therapy educator for 24 years, teaching both core curriculum and continuing education classes. He currently teaches anatomy and physiology at Purchase College, SUNY. He is the owner of The Art and Science of Kinesiology in Stamford, Conn., and is the author of The Muscle and Bone Palpation Manual, with Trigger Points, Referral Zones, and Stretching; The Muscular System Manual, 3rd edition; and Kinesiology, The Skeletal System and Muscle Function, 2nd edition (Elsevier, 2009, 2010, 2010), as well as other publications. For more information or to contact Joseph, visit www.learnmuscles.com.
comments powered by Disqus