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Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
December, 2015, Vol. 15, Issue 12
Massage and the Stress Response
Making Sense of the Existing Literature
By Massage Therapy Foundation Contributor
Contributed by Beth Barberree, BA, RMT; April Neufeld, BS, LMT; and S. Pualani Gillespie LMT, MSN, RN, BCMTB
Massage has long been seen as a way for people to decrease their stress levels. With the growing number of people seeking massage therapy care in recent years, it becomes increasingly important to understand if it is effective in managing the negative health consequences of stress. In this month's article review, we explore work from a team of experienced researchers who provided a review of the existing literature in this area.
Albert Moraska, Robin Pollini, Karen Boulanger, Marissa Brooks, and Lesley Teitlebaum in their 2008 article, "Physiological Adjustments to Stress Following Massage Therapy: A Review of the Literature," provided a critical evaluation of peer-reviewed research that had investigated the relationship between massage therapy and physiological measures of stress. The authors emphasized that reviews like this one are important to understanding the effectiveness of massage therapy in the management of the health impacts of stress.
In this literature review, massage therapy was defined as "the manipulation of soft tissues for the purpose of producing physiological effects on the vascular, muscular or nervous systems of the body." Only studies where massage therapy was applied within the context of this definition were included, so any studies involving light touch modalities were excluded. The research group only included studies where the massage was provided by trained therapists, and those with adults as the participants. This process of deciding what studies will be included and excluded is called setting the inclusion criteria.
With these criteria in mind, the research team conducted a broad and extensive search of several electronic research databases, along with the researchers' own libraries, for articles that pertained to "stress" in combination with "massage," "bodywork," "physiotherapy," and "manual therapy." Articles were included when "presenting dependent variables of stress that included the hormones cortisol, epinephrine, norepinephrine, or physical measures of blood pressure (BP) and heart rate." Of the initial 1032 citations reviewed that met the search parameters, only "25 articles were found to meet all inclusion criteria."
The research team found that the 25 studies employed a diversity of experimental methods. There was large variability in session duration, "from 5 to 90 minutes, with over half (52%) of the studies having a session duration between 20 and 30 minutes." Commonly, 6 to 10 treatments were delivered, but data was most often collected following the first session. The researchers chose not to report on specific massage techniques used as the specific techniques used were reported in varying degrees of detail and those studies had varied results.
"Study populations were varied and included sexually abused women, patients with eating disorders, pain conditions, hypertension, HIV positive diagnosis, cancer, post-operative patients, critical care patients, healthy adult populations, and some specific disease states." Hormones that are markers for stress response were also noted by the researchers in this review.
Salivary cortisol is easy to collect from the mouth and non-invasive, so massage therapy studies frequently use this method for assessing cortisol levels. Of those studies that measured reductions in salivary cortisol it appears that the decrease, although significant, may be short term. There does not appear to be a cumulative reduction in salivary cortisol levels with multiple massage treatments. The subject populations in these studies were highly varied, "which suggests that many groups may experience an immediate benefit from massage therapy for this variable. . . However, most study participants were either healthy adults or experiencing chronic life stress."
Urinary cortisol has been used to assess changes following multiple massage treatments. The studies that assessed urinary cortisol did so at baseline and after 5 weeks of twice-weekly massage and found evidence of a cumulative reduction in urinary cortisol.
"Epinephrine (adrenaline) is produced mainly from the adrenal medulla and reflects the subject's sympathomedullar activity" [activity from this gland]. "Epinephrine output is mainly influenced by mental stress."
"Norepinephrine (noradrenaline) is considered an indicator of sympathoneuronal [sympathetic nervous system] activity as most of the circulating norepinephrine is released from sympathetic nerve endings. This hormonal defense reaction is aimed at routing energy from organs to muscles for the muscles" and "is more responsive to physical activity" than to mental stress. However, the authors state a decrease in either of these hormones "may indicate a physiological reduction in stress" routing circulation from organs to muscles.
Cardiovascular responses reported in 16 of the studies were blood pressure and heart rate. "Increases in blood pressure, respiration and heart rate are all physiological manifestations of the sympathetic nervous system's response to stressful events." There were mixed results in the studies reporting these responses, with the differences including what body parts were massaged, the massage techniques applied, overall health of the study participants, duration of the massage session, and single session versus multiple sessions. No studies reported an increase in blood pressure. Also the effect of massage on heart rate, although not sustainable, seemed to be repeatable as decreases following massage occurred one visit after the next.
It was noted by the research team that their review was based on the outlined inclusion criteria. The authors contrasted their review with a meta-analysis completed by Moyer et al. (2004). Results of the two reviews were not consistent. The two reports differed with respect to levels of salivary cortisol and blood pressure; the Moyer et al. (2004) report found no massage sessions that affected salivary cortisol and did find a change for blood pressure. The authors of the current review conclude that the difference in findings reveals more about the current state of massage therapy research than about the clinical effects of massage therapy on stress measures. Overall, "the studies reviewed showed a variety of methodological shortcomings."
Of significant interest to readers is the authors' conclusion that, "to date, the research on massage therapy and stress has not progressed to demonstrate efficacy in a trial of sufficient size or methodological rigor to make definitive statements about its efficacy in reducing stress as measured by physiological variables in any particular patient population." It is unfortunate that the evidence does not support making strong conclusions about the impact of massage therapy on physiological stress indicators. It is also unclear why there is no mention of heart rate and blood pressure in the key words listed as search criteria in the current review, even though these non-hormonal markers of stress were included in the review. This may lead to difficulty in having this review come up in other literature searches.
The authors identify opportunities for future studies to examine the effectiveness of massage therapy. Based on the diversity among the studies in the current review, the authors emphasized the need for research that employs methodological rigor including large sample sizes, detailed and reproducible treatment protocols, and reporting of clinical and statistical significance.
The Massage Therapy Foundation continues to support and promote research as seen in this month's review. The Foundation is currently accepting scientific submissions for our 2016 International Massage Therapy Research Conference (IMTRC) that will be held in Seattle, Washington, May 12-15. More information about the conference as well as the submission guidelines are now available on our website at www.massagetherapyfoundation.org.
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