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The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
March, 2013, Vol. 13, Issue 03
Testing the Treatment Dose of Massage for Chronic Neck Pain
By Massage Therapy Foundation Contributor
Contributed By April V. Neufeld, BS, LMT, NCTMB; Jolie Haun, PhD, LMT; MK Brennan, MS, LMBT, RN, ACM
Researchers at the Group Health Research Institute in Seattle are improving the quality of research studies on massage therapy.This month's Massage Therapy Foundation's review is the Institute's latest project published in a recent BMC Complementary and Alternative Medicine publication, "Dosing study of massage for chronic neck pain: protocol for the dose response evaluation and analysis of massage [DREAM] trial."
"As with back pain, a plethora of options are available for treating neck pain, yet the most commonly used treatments lack consistent evidence of the effectiveness, especially for persons with chronic neck pain," write Sherman, et al. Although there have been a number of studies examining the benefits of massage for neck disorders, a review of the literature indicate the need for Sherman's study. "A major deficiency of previous studies [on massage therapy] has been their use of low ‘doses' of massage that massage therapists consider inadequate," in addition to the lack of massage as the primary treatment, treatment schedule, or descriptions of the type of massage used. And considering the lack of a standard protocol for evaluating massage therapy, it is not surprising that the benefits of massage therapy remain unspecific.
This study was designed to provide a foundation for rigorous research by evaluating three components of optimal dosing: 1) frequency of treatments per week; 2) length of each treatment session; and 3) total treatment period using a massage protocol that includes typically used techniques. Such research will determine the optimal minimal dose of massage for chronic neck pain. Unlike many of the research studies reviewed in this column, this study has not been completed; however it outlines the ideal methods for determining the optimal dose of massage therapy on chronic neck pain, providing details about protocol and treatment regimen not often published in massage related research. This addition to the massage therapy literature will contribute to advancing this area of research.
To start, the authors ran a small, randomized pilot trial to determine if clinical significance was seen among massage recipients by four weeks when receiving one 60 minute massage per week. In this subsequent research, the research team will recruit 228 participants with neck pain to receive different weekly doses of massage for four weeks to determine the optimal dose. The study was set up so the research team could evaluate five doses over several frequencies/week ( two or three 30-min treatments or one, two, or three 60-min treatments). Using the five dosing combinations, participants will be randomized to a wait-list control or treatment group to implement the study protocol. A second treatment period of six weeks with a weekly 60 minute massage or no treatment will follow the initial four weeks of study. This was chosen because, in the authors' previous trial, up to 10 treatments were given over a period of 10 weeks, allowing for evaluation of benefits of an additional six week treatment protocol.
Participants will include the general Seattle area population, of mixed race and gender, ages 20 to 64, who have had at least one primary care visit for neck pain within the previous 3 to 12 months and has a diagnosis of non-specific, uncomplicated neck pain. Exclusions include, but are not limited to, receiving massage for neck pain within the past year, or any massage in the last three months, mild neck (lasting less than three months) or complicated neck problems related to cervical radiculopathy, previous neck surgery, MVA within the past three months. Treatments will be performed by licensed massage practitioners at Group Health Research Institute, who have at least five years experience treating musculoskeletal pain, have practiced and are comfortable with the massage protocol.
A specific massage therapy protocol was written for both 30 min and 60 min sessions and includes: a Cervical ROM assessment; hands-on tissue warming; lymph drainage; neck work; LMP can address compensatory patterns found in upper body, upper and lower extremities, pelvis, etc. using supine, prone and/or side-lying positions; integration which may include cranio sacral techniques, stretching, rocking and other; and completion. Neck work is defined as skull through upper back/chest, C7/T1, clavicles to 2nd/3rd ribs and sternum. Massage strokes may include, in no specified order, friction on base of skull, long strokes down lamina from base of skull, slow friction of the anterior neck, slow friction to scalenes, deeper longitudinal stripping techniques running parallel to muscle fibers to encourage muscle lengthening, treatment of scar tissue along with areas affected by scar tissue, effleurage, petrissage of trapezius, paraspinals, spenius cervicus/capitus, levator scapula and SCM muscles as blending strokes between a-f above for relaxation and transition, stretching to finish and enhance soft tissue manipulation – including PNF, MET and any active assisted stretching.
Sherman, et al, will use the Neck Disability Index, a 10-item questionnaire, to assess neck pain and dysfunction and a pain index that will be provided at five weeks post treatment. Secondary measures will also be used to assess factors such as stress and days of restricted activity. A blinded telephone interview at five, 12 and 26 weeks post-randomization will be performed to determine the primary outcomes of neck-related dysfunction and pain. A further questionnaire on the Internet will be collected at 10, 16, 20 and 39 weeks to supplement the interviews. The study outlines data collection, processing and quality control with details on the protection of human rights, safety monitoring and what will occur should a participant experience adverse effects.
For readers aware of the many limitations of massage therapy research, this trial should be of great interest. Namely, the sample size is appropriately powered to provide a rigorous data set which will allow for interpreting findings in a conclusive manner. Further, the protocol and methods are clearly delineated, which will allow for subsequent replication of findings and be key for validating these study findings.
The publication of this rigorous research has several implications for the field of massage therapy research, the practice of massage and practitioners alike. First, a study of this caliber will advance the science of research in massage therapy by providing valid, reliable and ultimately conclusive findings. Second, using methods to demonstrate the mechanisms and dosages required to produce optimal benefits of massage therapy for conditions such as chronic neck pain will advance the practice in non-clinical and clinical settings as an integral part of integrative health care. Third, and maybe most critical for you the reader, this research provides a valid and reliable source for you to demonstrate evidence based practice for your clients, your students, health care providers and others who want to know how and why what you do works.
We look forward to the results of this trial being released and will report the findings in subsequent reviews sponsored by the Massage Therapy Foundation. Janet Kahn, PhD, LMT, one of the researchers who performed this study, will be presenting the keynote address on day three of the International Massage Therapy Research Conference – Presented by the Massage Therapy Foundation (IMTRC). Join us in Boston April 25-27, 2013, to hear Dr. Kahn present "Massage in 21st Century Healthcare: Let's Seize the Moment." Registration is now open.
Editor's Note: Want to hear more great research all in one place? Attend the International Massage Therapy Research Conference – Presented by the Massage Therapy Foundation April 25-27, 2013, in Boston, Massachusetts. Registration is now open. Learn more at www.imtrc.org.
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