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Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
January, 2016, Vol. 16, Issue 01
Does Massage Affect the Immune System Following Exercise?
By Massage Therapy Foundation Contributor
Contributed by April Neufeld, BS, LMT; Beth Barberree, BA, RMT; Derek R. Austin, PT, DPT, MS, BCTMB, CSCS
Massage therapy increasingly is integrated into the healthcare plan for individuals suffering from a multitude of conditions.In particular, athletes, and those people supporting the athletes, believe that massage therapy can yield many benefits that could aid the athlete biomechanically, physiologically, neurologically, and psychologically. However, when research articles were reviewed to examine the effects of massage therapy on the immune system, researchers found that the benefits were unclear. This month, the Massage Therapy Foundation's research column reports on a literature review published in Physical Therapy in Sport (2014): Immunological effects of massage after exercise. "The purpose of this [literature review]," wrote the authors, "was to describe and review the current literature on massage and its role in modulating immune parameters when applied after intense physical activity."
The authors searched databases (Pubmed Medline, PEDro, and Cochran) for controlled studies conducted between 1970 and 2012 using specific keywords: massage, myofascial release, acupressure, recovery, warm up, exercise-induced muscle damage, exercise, sport, immunology, and lymphocytes. And they only included studies where "massage was the main intervention, control subjects received a placebo treatment, immunological variables were measured, and all study participants were healthy people. Studies were excluded when subjects had a history of systemic disease, had less than 5 hours of physical activity each week, smoked, had been involved in intense exercise during the previous 4-months, or had a contraindication of training." While the literature search appears thorough, the authors did not clarify why they excluded articles where participants had been involved in intense exercise.
Of the original 739 studies initially identified that examined some aspect of immunology, massage therapy, or randomized controlled trials (RTC) relating to post-exercise recovery massage, all but five studies were excluded for final review because they did not meet at least one of the inclusion criteria. "The inclusion criteria were as follows: massage is the main intervention; control subjects receive a placebo treatment; immunological variables are measured, and all study participants are healthy individuals." This last inclusion, that study participants must be healthy, is of particular interest because often research is performed on populations with health problems and yet many massage therapists report their clients are mostly healthy individuals.
"The results of this review suggest that massage may exert an influence on immune parameters, especially when applied after high-intensity exercise," wrote the researchers. Some evidence suggested that massage helps support immune system response by impacting the levels of proinflammatory cytokines (important in the anti-inflammatory response). For example, in a study where massage was performed on Quadriceps, cytonkine levels s were found to be higher in the non-massaged Qquadriceps than in the treatedmassaged legQuadriceps. Since exercise can cause a potentially damaging inflammatory response, decreasing the levels of proinflammatory cytokines could be beneficial. The authors also wrote of the speculation that massage therapy induces a parasympathetic response and so "improvements in local circulation may indirectly reduce the proinflammatory cytokines." However, since much of this research is performed on only a single body part (e.g. one leg), it is difficult to assess the overall role of massage therapy on the parasympathetic system.
Two studies were compared that described the movement of neutrophils towards the focus of post exercise inflammation. But since each study examined different sized muscles, and each had different intensities and duration of exercise prior to the intervention, the researchers concluded that it is difficult to make generalizations about the effects of massage on neutrophil count without further research.
Despite the impact on a variety of immune system constituents, it was noted that only a reduced IgA level is associated with increased risk of infection. The review yielded only one study on the impact of post exercise massage on IgA levels, and that study found that significant recovery of IgA levels occurs following massage, especially in females.
Also notable to readers, may be that three of the five studies in the review found "no robust evidence of an immunological improvement after massage" (Hilbert, Sforzo, Swensen, 2003; Smith et al., 1994; Stock, Baum, Rosskopf, Schober, Weiss, Liesen, 1996). In contrast, only two studies supported the immunological benefits (Arroyo-Morales et al., 2009; Crane et al., 2012).
Systematic reviews can be useful for readers to get a broader understanding of a particular topic, but can raise more questions than they answer. Readers will recognize that there are many factors that can influence the results of a study: sample size, type of massage therapy performed, timing of the intervention, type of exercise the subjects were engaged in, and duration and intensity of the exercise. Of the five studies examined, all had different sample sizes. All studies used healthy and active subjects but not all studies examined the same kind of exercise or frequency of the physical activity. Each study had the massage therapy application applied to different body parts. Additionally, the review examined four studies that indicated there were greater immunological effects when the massage therapy was applied following a 2-hour delay post exercise. "The differences in training mode and intensity may have produced corresponding variations in the immunosuppressive effects obtained, influencing evaluations of the recovery achieved by massage," wrote the researchers. "The data in this review suggest that massage may have a more relevant effect on the immune response after exercise with a higher cardiovascular demand. However, further research is required to confirm this possibility."
The researchers report there were several weaknesses in the studies selected for the review. One was that there was no information on any adverse effects that could have indicated complications with massage therapy as an intervention. Sports massage therapists might be tempted to read the information about the 2-hour delay and think that they should use that model on the athletes they work with. However, it is important to remember that while the subjects studied were young and healthy, none of them participated in professional sports or were elite athletes who practiced at moderate/high-intensity levels of physical activity.
The authors of this review clearly pointed out that a main limitation of the studies was that although some reported cell count changes, further research is needed to understand if these cells are simply relocating in the body as part of an immune response or actually proliferating.
Systematic reviews are excellent ways for readers to get a broad view of various studies examining a single topic. And as researchers explore topics before beginning new studies, a review is especially helpful to inform new projects by seeing what studies could be improved upon.
For more information on other reviews that have been done on massage therapy, please read the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.
The Massage Therapy Foundation continues to support and promote research as seen in this month's review. Registration is now open for the 2016 International Massage Therapy Research Conference (IMTRC) that will be held in Seattle, Washington, May 12-15. Registration information as well as conference updates are now available on the website at www.massagetherapyfoundation.org.
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