resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
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.
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