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Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
April, 2012, Vol. 12, Issue 04
Thai Massage Reduces Pain
By Massage Therapy Foundation Contributor
Have your clients reported having pain between their shoulder blades? Have your clients ever asked about the effects associated with Thai massage? Do you provide Thai massage as a modality in your practice? If you answered yes to any of these questions, we at the Massage Therapy Foundation (MTF) are reporting on a new study that may be of interest to you.The study we're reporting provides evidence that Thai massage reduces pain, muscle tension, and anxiety in patients who had myofascial trigger points in the scapular region.
This study from Thailand investigates the effects of traditional Thai massage on scapulocostal syndrome (SCS), a musculoskeletal pain syndrome in the posterior shoulder area. Buttagat and colleagues compared the effectiveness of Thai massage to physical therapy treatments using ultrasound and heat packs in treating pain localized to the medial superior border of the scapula. Previous studies by the same research team showed that traditional Thai massage promotes relaxation and reduces stress in patients with back pain associated with trigger points.
In this pilot study, the authors recruited patients aged 18-50 years old who had "spontaneous scapular pain which had lasted longer than 12 weeks, and had at least one trigger point in the scapular region." An independent assessor, who was blind to which treatment the patient would receive and had no knowledge or effect on the outcome of the study, examined each patient for associated myofascial trigger points in the serratus posterior superior, rhomboid and levator scapula muscles on the affected side. Trigger points were defined as "the presence of tender points within palpable taut bands of muscle in areas that the patient identified as painful." A total of 20 patients were included in the study because they lacked any other known cause of their pain, nor had any contraindication for Thai massage — e.g. fracture or contagious skin disease.
The 20 participants were randomly assigned into two groups of 10 – a traditional Thai massage group (TTM) or the PT modalities group (PT). The TTM patients "received a 30-min session of TTM for nine sessions over a period of three weeks around the scapula region while lying on their side [in a position of] transverse adduction of their arm, plus protraction of the scapula." The same certified Thai massage therapist performed all nine treatments for each of the ten participants. The PT patients "received a 30-minute session of a hot pack and ultrasound therapy [for 10 min] for nine sessions over a period of three weeks in the same environment as the TTM group."
One common critique of any study investigating pain, especially those involving bodywork therapy, is that pain is inherently subjective. Buttagat and colleagues considered this objection and collected data using five different physiological and psychological outcome measures to assess the participants' experience of pain. Pain and tension were assessed using a horizontal visual analogue scale (VAS). The scale ranged from 0 to 10, with 0 indicating no pain or muscle tension, and 10 indicating the most pain or muscle tension ever experienced. The patients marked the line indicating their levels of pain intensity and muscle tension. Pressure pain threshold (PPT) was assessed using a pressure algometry technique involving participants giving a verbal signal when they began to feel pain or any discomfort (at which point the compression was stopped). State Anxiety Inventory (STAI), Thai version, was measured using a 20 item inventory of how the participant felt at the moment. Characteristic items included "I feel calm" and "I am regretful," and were answered in scale of severity (not at all, a little, somewhat, etc.). Patient satisfaction was determined through a questionnaire consisting of a 5-point scale (not satisfied at all, not satisfied, satisfied, very satisfied, and most satisfied).
All outcome measures were compared at three points – after the first treatment session (immediate effects on day one), one day after the last treatment session (short-term effects at three weeks), and two weeks after the last treatment session (long-term effects at five weeks). Patients were similar at baseline; the TTM group reported pain intensity of 5.2 and muscle tension of 5.5; slightly more compared to the PT group's pain of 4.4 and tension of 4.5.
The pain intensity, muscle tension, and state anxiety all showed significant improvements with treatment among patients in both groups at all time points. However, there was no change in PPT for the PT group. When comparing each outcome measure individually, the researchers found a significant improvement in the TTM group compared to the PT group, except for the STAI (immediate and long term effect). Just as important, patients were much more satisfied with the TTM therapy – all TTM patients indicated they were "most satisfied" or "very satisfied," compared to the majority of PT patients who reported that they were only "satisfied."
The PPT for the PT modalities group did not change at any point: there was no immediate response, nor was there response after nine sessions. For TTM, however, the pressure needed to elicit pain doubled after nine sessions. Compared to baseline, this was a highly significant change that was also significantly more than the PPT of the PT group at three weeks and at five weeks. Objectively, TTM reduced the pressure sensitivity of these chronically painful areas in only nine half-hour sessions.
While the study size was small, involving only ten people per group, it is highly likely that the effects shown here will be duplicated. Often, a large sample size is necessary to reveal small differences between groups. The differences between TTM and PT modalities were highly significant even with only the twenty participants. The major limitation of this design was that it is impossible to blind the therapists and the patients to the treatments, as is the case in the majority of massage studies. The authors concede that further study should include a "resting condition" or relaxation group where the patients would simply lie on their side for nine sessions of 30-minutes.
Buttagat and colleagues write, "We may therefore conclude that the treatment by TTM among patients with SCS was superior to the PT." However, the two PT modalities used here – heat pack and ultrasound for ten minutes – would likely not be the only treatments that these patients would receive in out-patient physical therapy practice.
If you use Thai massage, you can refer to resources such as this article to support Thai massage as an evidence-based practice. If you want to use Thai massage in your practice, the specific treatment protocols used in this study are included in the research article. However, these protocols are part of traditional Thai massage, which requires knowledge, skill and training for best results to result from this modality. Pursuing continuing education in Thai massage could be worthwhile in order to offer added pain relief benefits to your clients.
Source: Buttagat V, Eungpinichpong W, Chatchawan U, Arayawichanon P. Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome: a randomized single-blinded pilot study. J Bodyw Mov Ther. 2012;16:1:57-63.
For more information about the Massage Therapy Foundation, visit www.massagetherapyfoundation.org.
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