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Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Telecommuting and Technology: Ergonomic and Worker's Comp Considerations
As our world becomes more and more reliant on technology, equipment becomes more dependable and we become increasingly more comfortable with e-mail, the fax machine, the Internet and the smartphone, it is becoming easier and easier to work away from the office.
Medical Payola (Part 2)
Not only has Medtronic made billions selling expensive screws and hardware for highly controversial spine fusions, but a Senate investigation also found Medtronic felt compelled to write and edit medical journal articles attributed to outside physicians that downplayed the risks of the company's best-selling bone graft, Infuse.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
History Repeating Itself in Wisconsin?
Thirteen years ago, the Wisconsin Chiropractic Association (WCA) "agreed to settle Federal Trade Commission allegations that [the association] orchestrated a conspiracy among WCA members to increase prices for chiropractic services and to boycott third-party payers to obtain higher reimbursement rates."
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Repeating Bone-Density Tests
The U.S. Preventive Services Task Force recommends that women older than age 65 undergo bone-density testing. However, organizations in general have not stated when repeat bone-density testing should be done.
Wisconsin Exam in the Spotlight
You've passed your national boards with flying colors, including Part IV, the practical examination, at a combined cost of more than $3,000.
Spinal-Cord Injuries: Saying No to Steroids
With steroids, epidural and otherwise, in the news lately for their overuse when treating back pain (and their danger when tainted by fungal meningitis), it was high time for a policy change, and we've got one, from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons.
News in Brief
Cancer Treatment Centers of America Continues Support of Chiropractic; ACBOH Announces 2013 Practical, Written Exam Dates; PCORI Approves Funding for Research on Spinal Stenosis; Macquarie University to Cease Offering Chiropractic Program.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
Exercises for Back Pain: Low-Compression Training Program
This program is intended for two groups of people: 1) those who want to engage in resistance exercises for the major regions of their body without developing back pain in the process; and 2) those who already have back pain and want to do resistance exercises, but consistently re-irritate their back when trying to do so.
The Pallof Press for Core Stability Evaluation
Many people become injured because of instability, weakness and poor neural-sequencing patterns in the core. Lack of bracing and support from the inner core cylinder during coronal and transverse movements makes the body vulnerable to compensation injuries.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Calcium Supplements and Mortality
When the National Institutes of Health's AARP Diet and Health Study reported that men who took calcium supplements had a higher risk of dying from cardiovascular disease compared those who didn't, it was the third large cohort in six months with alarming findings regarding calcium supplements.
In a previous column, I discussed the history and definition of evidence-based practice (EBP), and expressed concerns with how the concept has been narrowly construed by some academics and payers.
Covering Chiropractic as a Profession, Not a Single Service
Recently Dynamic Chiropractic published a front-page article about various state essential health benefits and referred to Oregon and four other states not currently providing chiropractic as a covered benefit.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
Chiropractic Research: A Moral Issue
This year I've had the opportunity to go to three great chiropractic research conferences; the ACC-RAC, the Fédération Internationale de Chiropratique du Sport (FICS) Congress and the World Federation of Chiropractic Congress.
Business Building: What's Your Strategy?
I know some in our profession love to debate about whether or not spinal curvatures change as a result of our chiropractic adjustment, but I have a question that hits a little more close to the belt than that: Are chiropractors capable of change?
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
January, 2013, Vol. 13, Issue 01
Dosage Affects Immune and Endocrine Response to Massage
By Massage Therapy Foundation Contributor
Contributed By Derek R. Austin, MS CMT, Jolie Haun, PhD EdS LMT, Sandra K. Anderson, BA, LMT, ABT
If a weekly massage is helpful for stress relief and immune function, then two weekly massages must be twice as beneficial, right? The results might surprise you.The Massage Therapy Foundation's previous monthly research columns have reported research suggesting massage may reduce pain, stress, depression, anxiety and cortisol levels, and enhance certain immune function parameters. However, how massage produces these outcomes remains a largely unanswered question. In a new study published in The Journal of Alternative and Complementary Medicine, Dr. Mark Rapaport and his colleagues investigated the mechanisms of repeated massage.
The authors compared once and twice-weekly Swedish massage to two equivalent doses of light touch. Fifty-three participants were randomized to one of four intervention groups: five weeks of Swedish massage once-weekly or twice-weekly, or control light-touch once-weekly or twice-weekly. Eight of the 53 participants did not complete the five-week protocol for reasons unrelated to the study intervention, leaving 45 participants (22 male and 23 female). Therapy sessions of 45 minutes were performed by licensed massage therapists using a standardized, specified protocol with nonaromatic oils. The light-touch condition followed the same protocol as the Swedish massage except that the therapist used only light touch with the back of the hand. Blood neuroendocrine and immune samples and salivary cortisol samples were collected prior to and following the therapy sessions.
The twice-weekly massage group demonstrated greater changes in oxytocin, arginine vasopressin, ACTH, and cortisol than the twice-weekly touch group. Twice-weekly massage also increased mean pretreatment levels of CD56+ cells, but decreased all other circulating immune markers. Changes in pretreatment levels of cytokines in the once-weekly group were similar to the authors' previous study showing sustained decreases in many pro-inflammatory and other cytokines. Interestingly, these decreases in markers of inflammation were not observed in the twice-weekly intervention groups. The authors note that the weekly massages were separated by 7 to 8 days, while the twice-weekly sessions were separated by 3 to 4 days; therefore, observed differences may represent differences in length of time between sessions. Heart rate variability was also measured, but no differences were found between the groups. This is not surprising, since young, healthy (i.e. relatively unstressed) sample participants were studied.
Overall, the results can be summed up as follows: once-weekly massage demonstrated patterns of change in circulating lymphocyte markers and cytokines similar to what was observed after a single massage session. Once-weekly massage increased immune changes that were identified after a single session of massage, but had minimal effect on neuroendocrine function. By contrast, twice-weekly massage increased neuroendocrine changes with little effect on the immune markers studied.
These results are consistent with the authors' initial hypothesis that the positive effects of massage therapy might be mediated through oxytocin and arginine vasopressin. The authors conclude these may be sustained, cumulative, biologic effects caused by the massage and light touch interventions. As a whole, the current findings suggest that while these effects are sustained for several days, they were not merely additive; they effects are different depending on the dosage of the intervention. Another intriguing finding of this study is that the light touch condition, involving gentle, systematic, and comprehensive stroking of an individual for 45 minutes, does have impact on biologic activity. This finding calls into question the use of a light-touch group as a "placebo" for research.
These findings are compelling, but study limitations should be noted when interpreting results. The most pressing limitation of this study is the small sample size of the groups. However, this is often the nature of pilot studies. What is important is the results of this small sample warrant a larger follow-up study, which may provide findings that are more conclusive. The authors note that further investigation of dosage, length of treatment, and different massage techniques are needed. Another limitation is this study did not report measures of sympathetic and parasympathetic function, which could have been helpful for interpreting the findings.
These findings make a significant contribution to advancing the science of massage therapy research. Most therapists, and people in general, are aware that massage works but how it works and which dosages are optimal are questions that have remained largely unanswered and are continually being debated in the field. However, published data findings such as these are starting to provide some direction for finding answers to these massage therapy mysteries. These data provide a glimpse into the biological mechanisms of massage therapy and an indication of dosage response. Also notable from a research perspective, light touch does have a biological effect and is not the "placebo" it was believed to be in previously reported research. These findings can inform future studies use of biological outcomes measures, dosage protocols and the re-evaluation of what is an appropriate placebo.
So, what's the take home message? In general, these findings provide justification of repeated massage to promote sustained cumulative effects. However, it is important to be aware that different dosages of massage may result in different changes in biologic activity. Because of this, massage dosage may need to be adjusted based on the desired effect. For example, if immune function is a priority, once-weekly massage may be optimal for desired effect whereas, if neuroendocrine function is a priority, twice-weekly massage may be the best option. Massage therapists, and clinical providers who recommend repeated massage to their patients, can refer to research such as this article and other related research, to inform their dosage recommendations.
To learn more about previously reported research on the biological mechanisms and dosage effects of massage therapy, you can review the Massage Therapy Foundation website, read our previous articles in Massage Today, read accepted MTF Research Grant abstracts or search Pub Med for related massage therapy studies.
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