resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
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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